F. James Levinson

Household Food Security Is Inversely Associated with Undernutrition among Adolescents from Kilosa, Tanzania

Household food insecurity contributes to poor nutritional health, with negative consequences on growth and development during childhood. Although early childhood nutrition needs have received much attention, another important nutritional phase is adolescence. In a sample of 670 adolescents from Kilosa District, Tanzania, this study used 3 approaches to better understand the relationship between food insecurity and undernutrition. First, this study examined the associations between 3 commonly used measures of household food security and undernutrition among 670 adolescents from Kilosa District, Tanzania. The measures of household food security, energy adequacy per adult equivalent, dietary diversity score, and coping strategies index, were strongly correlated with each other and household assets (P < 0.05). Second, this study measured the nutritional status of adolescents in this district, finding a high prevalence of undernutrition (21% with BMI-for-age <5th percentile of the National Center for Health Statistics/WHO reference). Third, this study measured the association between the log odds of undernutrition (as the dependent variable) and each of the 3 measures of household food security. In separate models, household energy adequacy per adult equivalent and household dietary diversity score were inversely associated with undernutrition after adjusting for gender, age, puberty, and the interaction between age and puberty. By contrast, a greater use of coping strategies was not associated with undernutrition. Strategies focused on increasing household energy intake and improving dietary diversity among the most vulnerable households could improve the nutritional health of adolescents.

Factors Associated With Successful Pregnancy Outcomes in Upper Egypt: A Positive Deviance Inquiry

A positive deviance inquiry was conducted in Al-Minia, Upper Egypt, to identify factors associated with achievement of good pregnancy outcomes despite limited resources. As compared with women with poor weight gain (n = 30), low-income women with weight gain greater than 1.5 kg per month in the second trimester of pregnancy (n = 11) were more likely to report multiple antenatal care contacts (80% versus 43%), increased rest during pregnancy (67% versus 7%), and more consumption of meat (33% versus 13%) and vegetables (82% versus 37%), and were less likely to report symptoms consistent with urinary tract infection (50% versus 90% with dysuria and 0% versus 57% with cloudy or reddish urine). Similar characteristics distinguished low-income women in a more economically advantaged community whose newborns weighed more than 3 kg (n = 18) as compared with mothers of smaller newborns (n = 18). These characteristics were similar to those identified in the National Research Centers Al-Minia birthweight study. the positive deviance inquiry is an affordable, participatory step to identify accessible individuals, behaviors, and conditions for improved perinatal health.

Utilization of positive deviance analysis in evaluating community-based nutrition programs: An application to the Dular program in Bihar, India

Background Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities. Objectives To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of Indias Integrated Child Development Services on young children. Methods In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries—the poorest children with the best nutritional outcomes—and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children. Results The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%). Conclusions The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.

Morinda Revisited: Changes in Nutritional Well-being and Gender Differences After 30 Years of Rapid Economic Growth in Rural Punjab India

A follow-up study of malnutrition and its determinants among children 6 to 24 months of age was carried out in rural areas of Punjab State in India 30 years after the original study, and following a period of rapid economic growth. The original 1971 study had found a high prevalence of mortality and malnutrition and the worst gender difference in nutritional status ever recorded in an Indian study. The 2001 follow-up study found dramatic reductions in child mortality, child malnutrition, gender-based imbalances in child well-being and care, and family size, the result of participatory economic growth coupled with broad-based educational, health, and family-planning services. Despite overall improvements in caloric intake, however, 40% of lower-class children in 2001 were still consuming less than 50% of their caloric allowance. With minimal gender-based abortion and significantly reduced neglect and mortality of female children, gender balance among children in this area of rural Punjab improved markedly over the 30-year period.